Palliative Care Order Set - Stratis Health
Palliative Care Order Set - Stratis Health
Palliative Care Order Set - Stratis Health
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<strong>Palliative</strong> <strong>Care</strong><br />
<strong>Order</strong> <strong>Set</strong> Committee on Evidence-Based Practice/May 6, 2008<br />
Pain Management (Annotation #17) (Titrate for comfort except where noted)<br />
Mild pain medication options:<br />
Acetaminophen*<br />
Ibuprofen*<br />
Naproxen*<br />
Tramadol<br />
Malignant bone pain medication<br />
options:<br />
Ibuprofen*<br />
Naproxen*<br />
Dexamethasone*<br />
Combination medication options:<br />
Hydrocodone/Acetaminophen<br />
Oxycodone/Acetaminophen<br />
Opioid medication options:<br />
Fentanyl<br />
Hydromorphone*<br />
Morphine*<br />
Oxycodone*<br />
Neuropathic pain medication options:<br />
Amitriptyline<br />
Desipramine<br />
Gabapentin<br />
Nortriptyline<br />
Lidocaine patch<br />
Pregabalin<br />
Opioid reversing agent<br />
Naloxone*<br />
*See multi-symptom medications for specific orders<br />
Tramadol ____ mg (25-100 mg) by mouth 4 times daily as needed for pain (Reduce dose in patients with renal<br />
dysfunction. Caution: May cause delirium. Maximum dose is 400 mg/day.)<br />
Combination Medications (In addition to acetaminophen for mild pain, add the following):<br />
Hydrocodone 5 mg/acetaminophen 500 mg 1-2 tablets by mouth every 4 hours as needed for moderate pain<br />
(Consider if acetaminophen is prescribed for fever control; maximum dose is 4,000 mg per day.)<br />
Oxycodone 5 mg/acetaminophen 325 mg ____(1-2 tablets) by mouth every 4 hours as needed for moderate<br />
pain (Consider if acetaminophen is prescribed for fever control; maximum dose is 4,000 mg per day.)<br />
Obtain orders for constipation management/bowel care if opioids are prescribed<br />
Opioid Medications<br />
Fentanyl 20 mcg IV every 15 minutes as needed for severe pain. Evaluate after each dose<br />
Obtain orders for constipation management/bowel care if opioids are prescribed<br />
Neuropathic Pain Medications<br />
Amitriptyline ____mg (10-25 mg) by mouth daily at bedtime as needed for neuropathic pain (Avoid use in<br />
elderly patients.)<br />
Nortriptyline ____mg (10-25 mg) by mouth daily at bedtime as needed for neuropathic pain (Avoid use in<br />
elderly patients.)<br />
Desipramine ____mg (10-25 mg) by mouth daily at bedtime as needed for neuropathic pain (Avoid use in<br />
elderly patients.)<br />
Gabapentin (Reduce dose in patients with renal dysfunction.)<br />
For elderly patients, 100 mg by mouth daily at bedtime. Titrate up to 100 mg twice daily and then 100<br />
mg 3 times a day as needed for comfort<br />
For non-elderly patient, 100 mg by mouth daily at bedtime. Titrate up to 300 mg twice daily and then<br />
300 mg 3 times a day as needed for comfort<br />
Pregabalin 50 mg by mouth 3 times daily for neuropathic pain. Evaluate in 7 days. (Reduce dose in patients<br />
with renal dysfunction.)<br />
Transdermal lidocaine patch (1-3 patches) for neuropathic pain. Apply for 12 hours, remove for 12 hours<br />
Institute for Clinical Systems Improvement<br />
www.icsi.org<br />
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